Botswana, Mississippi? The Magnolia State's HIV Crisis

The third in a series examining the reports of a pediatric "functional cure" and its implications across Black America. In Part 1 we asked whether a Mississippi infant supposedly cured of HIV actually had the virus at all. In Part 2 we considered the mother's lack of prenatal care and the fact that she fell out of HIV care.

"Stunning" reports of an almost 20-month-old Mississippi infant who had been "cured" of HIV dominated news coverage during early March 2013. Most reports lacked context: The mother did not know that she was HIV positive until her delivery, and later she dropped out of care for almost a year.

This often happens "in states like Mississippi and South Carolina, where there has been a historic Black reliance on public health services," says Bambi W. Gaddist, Dr.P.H., founder and executive director of the South Carolina HIV/AIDS Council. "It's very easy for an HIV-positive pregnant woman to be identified much later in the process. And the 'process' has become overburdened and underfunded."

The Worst State to Have HIV?

Connecting people living with HIV/AIDS to medical care and treatment as soon as possible -- known as "treatment as prevention" -- has become a critical strategy in ending the epidemic. Some experts believe that Mississippi's conservative politics, underfunding of HIV/AIDS programs and growing socioeconomic disparities both fuel the epidemic and increase the likelihood that more HIV-positive men and women will drop out of care -- if they receive it at all.

Black America sits at the epicenter of the domestic HIV/AIDS epidemic. Blacks represent only 13 percent of the nation's population but about 44 percent (pdf) of all new HIV infections, according to the Centers for Disease Control and Prevention. Mississippi boasts the highest percentage of Blacks of any state -- nearly 38 percent -- and Black people make up almost 80 percent of all new infections there.

"So it's very likely the mother and newborn were Black," says Dr. Gaddist.

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In 2011 Mississippi had the sixth-highest rate of new HIV cases in the nation. The state ranks with Florida for having "the highest HIV rates among individuals 13 to 19 years old. Jackson [had] the third-highest HIV infection rate of all U.S. metropolitan areas ... in 2009," reports the Mississippi State Department of Health.

"Meanwhile, an abstinence-education statute forbids even programs offering information about condoms to demonstrate how to use them, but does include a requirement to mention the anti-sodomy laws still on the books," salon.com reported in a piece that described Mississippi as "the worst state in America to have HIV."

Veteran HIV/AIDS activist Sean Strub, the founder ofPOZ and the Sero Project, disagrees with that assessment. "Sadly, there is a lot of competition for that title. Anyone getting prosecuted for having HIV might find the state they're living in the 'worst.' For most people with HIV, the 'worst' state for a person with HIV is the one where they live. Holding out Mississippi specifically as so much worse is [also] a way of implying how good it is somewhere else."

Promoting Prejudice

There also is an "overwhelming stigma associated with HIV/AIDS among African Americans in southern USA," reports The Lancet. "Many individuals [forgo] testing not only because of limited access to health services, but because of paralysing stigma."

"From the interviews that I have done with HIV-positive women in Mississippi and across the South, many have said that they had to get over the fact that they were HIV positive before they moved into care," says Kimberly A. Parker, Ph.D., assistant professor of health studies at Texas Woman's University. "There are many negative attributes associated with being HIV positive among Black people, especially in the South. Also, in the Black community, we still have so much stigma associated around men who have sex with men."

"I've been called a nigger and a faggot by state legislators right in the Capitol," Alonzo Dukes, executive director of the Greenville-based Southern AIDS Commission, told Human Rights Watch, which released a highly critical indictment of the state's HIV/AIDS policies.

"Mississippi laws and policies contribute to the problem by promoting prejudice and discrimination against those vulnerable and perceived to be vulnerable to HIV," the report says. "In some instances, state public health workers have been found to harass and threaten people testing positive for HIV."

Mississippi Public Broadcasting reports that Mississippi ranks 48th in the nation in public health funding. The state provides few dollars for prevention, housing or prescription-drug programs for PLWHA. HIV/AIDS activists have been fighting massive proposed cuts to the state's paltry HIV/AIDS funding -- slashing almost $10 million from the Mississippi State Department of Health's budget of $29 million.

Activists have opposed the state's policies and funding cuts and have called attention to their plight by occupying the statehouse grounds.

Mississippi Burning

The funding cuts are happening at the same time "nearly two-thirds of people in Mississippi with HIV are without treatment," The Clarion-Ledger reports. The "rate [is] comparable to that in Botswana, Ethiopia, and Rwanda," Human Rights Watch says. Reducing funding for HIV care and treatment would likely exacerbate these conditions.

Republican Gov. Phil Bryant and the Republican-led state Legislature have filed suit to oppose federal health-care reform -- despite widespread poverty and high rates of people without access to health care. In recent months the Republican leadership has also fought Democratic attempts to expand Medicaid and add hundreds of thousands of the working poor to the rolls.

Red tape and unnecessary regulations add to the misery of many PLWHA.

"Mississippi is one of the few, and maybe only, states that requires an in-person appointment to renew your Medicaid," Luke O. Versher, a field organizer for AIDS Action Mississippi, told Housing Works. "Many people don't have the transportation, miss their appointments, and that's how they keep enrollment down."

Rod McCullom has written and produced for ABC News and NBC, The Atlantic, Ebony, the Los Angeles Times and others. He writes on politics, pop culture and sexuality at Rod 2.0.

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